Governments urged to address impetus behind global obesity

Because of the complex interaction between changes in the global food system, growing economies and country- and culture-specific approaches to nutrition and physical activity appear to play an important role in the worldwide obesity epidemic; therefore, researchers are calling for governments to institute more aggressive public health policies and prevention efforts.

Worldwide, about 1.5 billion adults are overweight, another half billion are obese and 170 million children are also considered overweight or obese. In many countries, obesity accounts for 2% to 6% of health care costs and is now the largest preventable cause of disease in certain areas, including the United States.

“One of the leading threats [to public health] that governments face, and have so far failed to address adequately, is the obesity pandemic,” Richard Horton, BSc, MB, FRCP, editor-in-chief of The Lancet, said during a press conference.

In September, U.N. member states will convene to discuss non-communicable diseases, and the rising prevalence of obesity worldwide may be the “the toughest challenge that they face,” Boyd A. Swinburn, MD, member of the WHO Collaborating Centre for Obesity Prevention and Deakin University in Melbourne, Australia, and colleagues wrote in a paper published in The Lancet.

“We hope that that the international community will take some heed,” Swinburn said at the press conference.

Environmental contributors

In the paper, Swinburn said middle- and low-income countries, which now bear the brunt of the obesity epidemic, may just be feeling the effects of a shift toward mechanization and mobilization while simultaneously having increased access to processed, high-calorie foods. Nevertheless, these lower-income regions exhibit different trends in the spread of obesity compared with higher-income countries: Whereas obesity generally affects men, women and children in lower socioeconomic tiers in high-income countries, middle-aged women living in urban areas are more likely to be obese in low-income countries.

Swinburn also said obesity remains more prevalent in certain countries. For instance, obesity is more common in the United States and the United Kingdom, where cars serve as a primary mode of transportation, than in the Netherlands, where there is a greater emphasis on cycling. In addition, cultural perception of body image is important. In Tonga, where seven in 10 women are obese, a large body frame is desirable. Conversely, in Japan, where a smaller body type is preferred, only one in 20 women is obese.

Policy problems

Although obesity appears to be largely dependent on environment, Swinburn said the global food system is also a major common factor.

“Because this all happened around the same time, this points to global drivers of the epidemic,” he said. “There is a lot of evidence coming out that the epidemic is driven largely by changes in the food system.”

The obesity epidemic began in the 1970s and has been a growing problem for the last 40 years, according to Swinburn.

The first half of the 20th century ushered in an era of mechanization and mobilization that led to reduced energy expenditure. The prevalence of obesity, however, remained low as natural appetite mechanisms regulated caloric intake. Unfortunately, an “energy balance flipping point” occurred during the late 1960s and 1970s triggered by changes in the food system and supply, such as increased availability of processed affordable and highly promoted tasty food.

“This led to a push effect from food systems, resulting in a passive overconsumption of calories,” he said.

These issues were exacerbated by economic policies and systems that promote consumption without much limit on overconsumption, according to Swinburn. He also said current efforts for fighting obesity focus on drugs, surgery and health promotion programs that do not address the problem’s roots.

“There is an urgent need for healthier, sustainable, equitable food systems and built environments,” Swinburn said. “At the policy level, we need a lot more action than is happening at the moment.”

For more information:

Swinburn BA. Lancet. 2011;doi:10.1016/S0140-6736(11)60813-1.

Disclosure: Dr. Swinburn and colleagues report no relevant financial disclosures.

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